HHS Tribal Consultation Policy
U.S. Department of Health and Human Services
Fourth Annual Tribal Budget Consultation Meeting
Hubert Humphrey Building
Deputy Secretary's Conference Room, 6th Floor
200 Independence Avenue, SW
Washington, DC 20201
Wednesday, May 29, 2002
Moderator - Chris McCabe, Director, Office of Intergovernmental Affairs, HHS
Morning Session
Opening Blessing -- Julia Davis, National Indian Health Board , Nez Perce Tribe
Welcome -- Chris McCabe, Director, Office of Intergovernmental Affairs, HHS
HHS Opening Remarks -- Claude A. Allen, Deputy Secretary, HHS
Mr. Allen said this session represents the attempt of the Department of Health and Human Services to listen to tribal leaders present heir priorities and express the needs of Indian Country. Each division in the HHS Department will have representatives here, and all will listen carefully to what the tribal leaders have to say. Mr. Allen noted that the agenda summarizes the current priority concerns of Indian Country, including homeland security threats we face together. He said that the department has reactivated the Interdepartmental Council and has delegated staff to work in the regions determining how to proceed. He also discussed the HHS effort to eliminate health disparities.
Tribal Priorities - Jackie Johnson for Tex Hall, National Congress of American Indians
Ms. Johnson said that the number one concern of America's Indian tribes is the flat budget for Indian programs offered in HHS's portion of President Bush's 2003 budget. This money is supposed to meet the needs of a service population that is rapidly increasing, and it is also supposed to remedy disparities caused by generations of unequal treatment and neglect. Within that budget, appropriations for the Indian Health Service are critical to meeting the national goal of eliminating health disparities, and the Administration has requested less than one fifth of what collaborative work groups have identified as enough money to meet tribal needs.
Other priorities for the FY2003 budget include Economic Development, particularly ANA grants; Aging grants providing services for a growing number of Indian elders; Head Start and other children's programs, including the need to reduce regional staff caseloads and build human and physical infrastructure; the PERORA approach to administering TANF programs; and funding for Homeland Security programs, which directly impact Indian tribes with tribal lands on America's borders and in areas containing vulnerable military and scientific targets.
Indian Health Issues - Taylor McKenzie, M.D. -IHS Budget Team; Navajo Nation
Dr. McKenzie was assisted by Willie Jones, of the Lummi Nation, Robin Carufel, of the Lac du Flambeau tribe, and Julia Davis, of the National Indian Health Board. The panel summarized the legislative and executive policy foundations underlying Federal responsibility for Indian health care, and linked that responsibility with current presidential and departmental health initiatives. Dr. McKenzie reviewed the major health status and disparity data which demonstrates the strong need for health care interventions in the area of chronic diseases, such as diabetes, heart disease, and cancer; preventable problems such as accidental death or injuries and infant mortality; and behavioral health issues, including alcoholism, substance abuse, domestic violence, and suicide. These illnesses and disabling conditions are the focus of the Healthy People 2010 initiative as well as a number of other Federal programs and initiatives.
The panel reported on a proposed needs-based budget of $18,253,458 designed to serve basic health needs of Indian people as well as to address and reverse the trend of the major health disparities according to HP2010 goals of the DHHS. Details of this proposed budget, developed by the Indian Health Service Budget Formulation Team, were presented. Mr. Loren Sekayumptewa of the Hopi Nation spoke briefly about budget implications of the special health needs of the Urban Indian population and the difficulties faced by that large proportion of the American Indian population struggling to live outside the reservations. Ms. Hilda Moss of the Northern Cheyenne Nation discussed economic and other concerns that impact diabetes treatment on reservations and in frontier areas.
The panel also gave agency-specific recommendations on allocations and set-aside funding for outreach, research, and treatment of American Indian/Alaskan Native populations. Mr. Buford Rolin discussed structural issues relating to the Indian Health Service, particularly as regards the Agency's One-DHHS and Management initiatives. A series of recommendations was given to improve the structure, coordination, and functioning of the Indian Health Service within the overall DHHS structure.
Title VI Self-Governance and Title V Regulations - Ron Allen, Jamestown S'Klallam Tribe
Mr. Allen reviewed the long history of underfunding of Indian health services, and outlined a series of persuasive reasons for considering expansion of direct grant funding to Indian tribes and tribal organizations as a method for achieving cost savings through outsourcing.
Homeland Security - Rosalind Taveapont, Northern Ute Tribe; Vincent Toya, Jemez Pueblo
Mr. Toya and Ms. Taveapont discussed the special concerns shared by Indian tribal nations in the West, Southwest, and border areas on both the Mexican and Canadian borders concerning terrorism and bioterrorism. Among these are the co-location of many Federal and military installations, including weapons and health laboratories, in or near Indian lands. Another concern is the interaction of regional poverty with ease of border penetration, leaving large portions of border territory loosely patrolled or regulated by law enforcement personnel. The government was urged to involve Native American representatives more closely in consultation regarding homeland security. Further, the status of tribes applying for money to develop and enhance preparedness programs needs to be scrutinized and clarified so that tribes are not prevented by competition (from state governments) from protecting their citizens.
HHS Programs, Economic Development, and Social Services Needs - Tim Martin, United South and Eastern Tribes
Mr. Martin talked about the many state/tribal relations issues that have been exacerbated by the devolution of Federal funding down to the state and local level in many Federal programs. The imbalance that results in this devolution penalizes Indian tribes in all but the few states where Indians have the largest representation among the state's population. Many states have conflictual relationships with Indian tribes, while others dismiss Indian concerns due to their small numbers, assuming that the BIA or HIS will take care of their needs. Welfare, children's, and behavioral health programs are among the programs where these problems are most severe.
Head Start & Child Development Issues - Willie Jones, Jim Knapp, NICWA, Seneca Nation, and Julie Quaid,
The panel discussed a range of issues relating to children's programs under DHHS. Among these are foster care and adoption assistance, as well as child welfare, which are of particular concern to tribes whose children are losing all exposure to their own language and culture through adoption policies and programs of state governments. Mr. Knapp presented several recommendations relative to consultation issues that need to be discussed with state representatives in order to bring Indians to the table in resolving some of these problems. Impacts of state competition and neglect in administering social service block grants and other DHHS funds were touched on, and recommendations made for language and policy changes that would make it possible for tribal leaders to have increased influence over the welfare of their tribes' most vulnerable members. Ms. Quaid discussed infrastructure, transportation, and construction problems that greatly impact the quality of Head Start and other children's programs and reduce their range and effectiveness.
Child Support, TANF & Related Programs - Tex Hall, National Congress of American Indians; Mandan, Hidatsa, Arikara Nation
Mr. Hall painted a picture of Indian tribes caught in the crossfire of an overall outmigration of the general population in frontier states, coupled with the homecoming of Indian tribal members in need of health and social services. The combination of limited and reduced financial resources with increased numbers in need of these resources is creating crises in many parts of Indian Country. He described the efforts of his organization to make strides in economic development through partnership and job creation programs in order to attract enough capital to promote real economic self-sufficiency and growth among Indian tribes - a growth that would have the effect of lifting all boats.
Urban Indian Issues - Loren Sekayumptewa, National Council of Urban Indian Health, Hopi Nation
Mr. Sekayumptewa gave additional detail on the Urban Indian population of the country, which currently represents 57% of the American Indian/Alaskan Native population, but which receives only 1% of IHIS funding. This leaves that population struggling to survive in high-cost urban areas outside of reservations with few or no healthcare services. Several ways to benefit this isolated and underserved population were suggested.
Elderly and Aging Issues - Gary Kodasett, National Indian Council on Aging,
Mr. Kodasett discussed the plight of Indian elders. The greatest need for this subpopulation is for training money, since there is high turnover among elder advocacy program managers and staff, and a complex pattern of Federal, state and local programs that elders need detailed guidance about. National programs such as Medicare and Social Security have an underparticipation of Native American elders, who are not informed of their eligibility or about the rules and procedures involved in participating. Special problems that stymie Indian elder advocates include program design issues around the Medicaid and Medicare programs which bias application of these programs in favor of the general population. Discussion around this topic included issues concerning prescription drug costs, the lack of in-home care options for Indian elders, and the overall impact on frail elders of the lack of other services on Indian reservations, including heat, water, and power.
Tribal Wrap Up - Tribal Moderators
Tribal representatives asserted their strong commitment to working together with DHHS to identify, address, and resolve the problems they had raised in this consultation, and to collaborate in information sharing and participation in one another's conferences and task force groups. Tex Hall recommended a higher-level and more proactive committee structure similar to those in use by other Departments to facilitate the budget process during the passback phase.
HHS Summation - Janet Hale, Assistant Secretary for Budget, Technology & Finance
Ms. Hale discussed the complexity of the Congressional appropriations process and potential impacts of that process on the proposed $1 billion increase which is currently in that appropriations package. She reiterated the Department's commitment to working together with American Indians and Alaskan Natives to bring about fewer health disparities and greater access to services. She stressed that consultation and open communications between departmental representatives and tribal representatives will continue and increase, and asked tribal representatives not to hesitate to raise issues and problems whenever they come up.
Both groups thanked one another for their participation. Mr. Hall described the long and honorable record of service that American Indians have earned in serving their country in war after war, despite the great suffering their people had endured because of U.S. government actions and decisions. He stated his belief that this love of country was the greatest thing helping both groups work together to make things better for all their people.
Closing Prayer - Hilda Moss, Northern Cheyenne Nation
Last revised: November 10, 2003
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